Muscle strength and flexibility characteristics of people displaying excessive medial knee displacement

Bell DR, Padua DA, Clark MA. Muscle strength and flexibility characteristics of people displaying excessive medial knee displacement.

Objective

To determine differences in strength and range of motion (ROM) between participants who exhibit medial knee displacement (MKD) during a squat that is corrected by a heel lift and those who do not.

Design

Case control.

Setting

Sports medicine research laboratory.

Participants

Thirty-seven healthy subjects (control, 19; MKD, 18) with no lower-extremity injury in the past 6 months volunteered to participate.

Interventions

Not applicable.

Main Outcome Measures

Peak force was measured in newtons using a hand-held dynamometer and passive ROM was measured in degrees with a goniometer. Separate multivariate analyses of variance were used to determine differences in strength and ROM between groups. Post hoc testing was used to elucidate differences between groups.

Results

The MKD group had the following: greater hip external rotation strength (P=.03), increased hip extension strength (P=.01), less plantarflexion strength (P=.007), and increased hip external rotation ROM (P=.008).

Conclusions

The MKD group exhibited tight and weak ankle musculature. Interventions focusing on improving strength and ROM of the ankle may improve kinematics during a squat.     

A Comparison of Functional Electrical and Magnetic Stimulation for Propelled Cycling of Paretic Patients

Szecsi J, Schiller M, Straube A, Gerling D. A comparison of functional electrical and magnetic stimulation for propelled cycling of paretic patients.

Objective

To compare isometric torque and cycling power, smoothness and symmetry using repetitive functional magnetic stimulation (FMS) and functional electrical stimulation (FES) in patients with paretic legs with preserved sensibility and in patients without sensibility.

Design

Repeated-measures design.

Setting

Laboratory setting.

Participants

Eleven subjects with complete spinal cord injury (SCI) and 29 subjects with chronic hemiparesis (16.6±5.5mo poststroke) volunteered.

Interventions

Using a tricycle testbed, participants were exposed to isometric measurements and ergometric cycling experiments, performed during both 20Hz FMS and FES stimulation. Subjects with hemiparesis and with complete SCI were stimulated at maximally tolerable level and maximal intensity, respectively.

Main Outcome Measures

Maximal isometric pedaling torque and mean ergometric power, smoothness, and symmetry were recorded for voluntary, FES, and FMS conditions.

Results

Two different patterns of the efficacy of FMS were identified. (1) Patients with complete SCI did not benefit (less torque and power was evoked with FMS than with FES, P<.003 and 10⁻⁴ respectively). (2) Patients with hemiplegia and preserved sensibility could improve their torque output (P<.05), smoothness, and symmetry of pedaling (P<.05) with FMS more than with FES.

Conclusions

FMS is a potential alternative to surface FES of the large thigh musculature in stimulation-supported cycling of patients with partially or completely preserved sensibility.     

Intrinsic Properties of the Knee Extensor Muscles After Subacute Stroke

Horstman AM, Gerrits KH, Beltman MJ, Koppe PA, Janssen, TW, de Haan A. Intrinsic properties of the knee extensor muscles after subacute stroke.

Objective

To characterize muscle properties of paretic lower-limb (PL) and nonparetic lower-limb (NL) knee extensors in patients with subacute stroke.

Design

Case-control study.

Setting

Rehabilitation center research laboratory.

Participants

Patients with subacute stroke (n=14) and able-bodied age-matched control subjects (n=12).

Interventions

Not applicable.

Main Outcome Measures

Half relaxation times (HRTs) and maximal rates of torque development (MRTDs) were assessed as indicators of contractile speed using both voluntary and electrically evoked contractions. Moreover, changes in torque were measured during a fatigue protocol (35 electrically evoked intermittent contractions; 1.5s on, 2s off) and recovery.

Results

No differences among groups were found for normalized MRTDs during electrically evoked contractions (P=.117). However, during voluntary contractions both PLs (53% of control, P=.022) and NL (71% of control, P<.001) had significantly lower MRTD compared with control. Both PL (134% of control, P=.001) and NL (123% of control, P=.032) had significantly higher HRTs than control, indicating muscle slowing in patients with subacute stroke. PLs fatigued more and faster than control (P=.011) and both PL and NL recovered slower (P<.001).

Conclusions

The changes in HRTs and fatigue suggest adaptations in muscle properties toward slower, more fatigable muscle shortly after stroke. The inability to make use of contractile speed because of impaired neural activation seems the most limiting factor during the initial phase of torque development in PL. Thus, besides strengthening, muscle endurance and speed should also be addressed during rehabilitation.     

Relationship Between Age and Spasticity in Children With Diplegic Cerebral Palsy

Pierce SR, Prosser LA, Lauer RT. Relationship between age and spasticity in children with diplegic cerebral palsy.

Objective

To examine the relationship between passive torque, reflex activity, co-contraction, and age during the assessment of spasticity of knee flexors and extensors in children with spastic diplegic cerebral palsy (CP).

Design

Retrospective.

Setting

Pediatric orthopedic hospital.

Participants

Children (N=36) with spastic diplegic CP.

Interventions

Not applicable.

Main Outcome Measures

Spasticity of the knee flexors and knee extensors (as measured by peak passive torque, mean passive torque, reflex activity of the medial hamstrings, reflex activity of vastus lateralis, and co-contraction) was assessed during passive movements completed using an isokinetic dynamometer with concurrent electromyography.

Results

A significant positive relationship was found between age and mean knee flexor passive torque (P<.05), while a significant negative relationship was found between age and mean percentage of the range of motion with co-contraction (P<.05).

Conclusions

Our results suggest that passive stiffness may play a larger role in spasticity than reflex activity as children with spastic diplegic CP age. Additional research is needed to determine whether subject age could influence the effectiveness of interventions, such as serial casting or botulinum toxin, for spasticity in children with spastic diplegic CP.     

Light Touch Cue Through a Cane Improves Pelvic Stability During Walking in Stroke

Boonsinsukh R, Panichareon L, Phansuwan-Pujito P. Light touch cue through a cane improves pelvic stability during walking in stroke.

Objective

To examine the effect of a light touch cue provided through a cane on mediolateral (ML) pelvic stability during walking in subjects poststroke.

Design

Crossover trial examining ML pelvic stability during walking using a cane with the force contact and touch contact methods.

Setting

Physical therapy clinic, tertiary care center.

Participants

Subacute patients (N=40) with stroke with a mean age of 59.6 years and mean stroke duration of 46.8 days. The average gait speed with a cane was .13m/s (.05-.29m/s).

Intervention

Using a cane with the force contact and touch contact methods during walking.

Main Outcome Measures

ML pelvic stability as measured by averaged peak-to-peak pelvic acceleration, muscle activation of bilateral tensor fascia latae (TFL), semitendinosus (ST), and vastus medialis (VM) using an electromyography system, and vertical cane force.

Results

The average amount of cane force during touch contact and force contact cane use conditions was 2.3N and 49.3N, respectively. A light touch cue through a cane was required only when the paretic leg accepted the body weight, and this cue can provide ML pelvic stability (.16g of average pelvic acceleration) during walking to the same degree as the force contact method of cane use. However, significant increases in single-limb support duration with higher activations of TFL, VM, and ST muscles on the paretic leg were found during the paretic stance phase when using a cane in the touch contact fashion (P<.05).

Conclusions

A light touch cue can be provided during walking through the use of a cane. This augmented somatosensory information provides lateral stability during walking for subjects with stroke by facilitating the activations of weight-bearing muscles on the paretic leg during the stance phase.     

Effect of a bout of leg cycling with electrical stimulation on reduction of hypertonia in patients with stroke

Yeh C-Y, Tsai K-H, Su F-C, Lo H-C. Effect of a bout of leg cycling with electrical stimulation on reduction of hypertonia in patients with stroke.

Objectives

To evaluate whether a bout of leg cycling in patients with stroke reduces muscle tone and to determine whether neuromuscular functional electrical stimulation (FES) to the affected leg during cycling is more effective than cycling without FES.

Design

Within-subject comparison.

Setting

University hospital.

Participants

Patients with stroke (N=16; age range, 42-72y; <8wk poststroke) with hypertonia in the affected leg.

Interventions

Subjects' affected leg (1) performed cycling exercise with the assistance of FES (assisted-cycling session) and (2) performed cycling exercise without the assistance of FES (nonassisted-cycling session). Subjects sat in a specially designed wheelchair positioned on a resistance-free roller for each 20-minute session.

Main Outcome Measures

Changes in muscle tone pre- and posttest session were compared by using the Modified Ashworth Scale and the pendulum test (relaxation index and peak velocity).

Results

Modified Ashworth Scale scores were significantly lower (P<.05) and relaxation index and peak velocity values were significantly higher (P<.05) after both sessions. Changes in Modified Ashworth Scale scores, relaxation index, and peak velocity values showed a significant (P<.05) difference between the 2 sessions, and assisted cycling reduced hypertonia more than nonassisted cycling.

Conclusions

The hypertonia of patients with stroke showed a significant decrease immediately after a bout of leg-cycling exercise. FES-assisted leg cycling was better than nonassisted cycling for reducing hypertonia.     

Fatigue resistance during a voluntary performance task is associated with lower levels of mobility in cerebral palsy

Moreau NG, Li L, Geaghan JP, Damiano DL. Fatigue resistance during a voluntary performance task is associated with lower levels of mobility in cerebral palsy.

Objectives

To investigate muscle fatigue of the knee flexors and extensors in people with cerebral palsy (CP) compared with those without motor disability during performance of a voluntary fatigue protocol and to investigate the relationship with functional mobility.

Design

A case-control study.

Setting

A biomechanics laboratory.

Participants

Ambulatory subjects with CP (n=18; mean age, 17.5y) in Gross Motor Function Classification System (GMFCS) levels I, II, and III and a comparison group of age-matched subjects (n=16) without motor disability (mean age, 16.6y).

Interventions

Not applicable.

Main Outcome Measures

The voluntary muscle fatigue protocol consisted of concentric knee flexion and extension at 60° a second for 35 repetitions on an isokinetic dynamometer. Peak torque for each repetition was normalized by the maximum peak torque value. Muscle fatigue was calculated as the rate of decline in normalized peak torque across all repetitions, represented by the slope of the linear regression. Self-selected and fast gait velocities were measured as well as the Pediatric Outcomes Data Collection Instrument (PODCI).

Results

Greater fatigability (slope) was observed in the comparison group for both knee flexors and extensors than in the group with CP. Within CP, lower knee extensor fatigue (slope) was associated with lower functioning GMFCS levels and lower levels of activity and participation as measured by the PODCI transfers and basic mobility.

Conclusions

Even after adjusting for maximum peak torque, the knee flexors and extensors of participants with CP were observed to be less fatigable than age-matched peers without motor disability. The lower rate of muscle fatigue was also associated with lower functional mobility in CP. These results may be related to strength or activation differences and/or muscle property alterations. Future investigations are warranted.     

Stepping in Persons Poststroke: Comparison of Voluntary and Perturbation-Induced Responses

Objectives

To examine the stepping performance during voluntary and waist-pull perturbation-induced step initiation in people with chronic stroke.

Design

Repeated-measures single-case design.

Setting

University-based research laboratory.

Participants

Community-dwelling stroke survivors (N=10).

Interventions

Not applicable.

Main Outcome Measures

Ground reaction forces and kinematic data were recorded to assess anticipatory postural adjustments (APAs) and step characteristics for both voluntary and induced stepping conditions.

Results

Induced stepping was performed with both the paretic (35% trials) and nonparetic legs (65% trials). Induced first steps occurred earlier and were executed faster than rapid voluntary steps. Compared with voluntary stepping, induced first step APAs were shorter in duration. Step height was higher with the nonparetic leg for both stepping conditions. Use of the paretic leg increased (52%) during the diagonal perturbations that passively unloaded the stepping limb compared with the use of the paretic leg (33%) for forward perturbations.

Conclusions

The results indicated differences in executing voluntary and induced stepping, and between the paretic and nonparetic limbs in individuals with chronic stroke. The findings suggested guidelines for using stepping as a component of neurorehabilitation programs for enhancing balance and mobility. Additional larger-scale studies remain to be undertaken to further investigate these issues.     

Age-Related Differences in Lower-Limb Muscle Cross-Sectional Area and Torque Production in Boys With Duchenne Muscular Dystrophy

Mathur S, Lott DJ, Senesac C, Germain SA, Vohra RS, Sweeney HL, Walter GA, Vandenborne K. Age-related differences in lower-limb muscle cross-sectional area and torque production in boys with Duchenne muscular dystrophy.

Objective

To examine the relationship between lower-extremity muscle cross-sectional area, muscle strength, specific torque, and age in ambulatory boys with Duchenne muscular dystrophy (DMD) compared with controls.

Design

Observational cross-sectional study.

Setting

University research setting.

Participants

Volunteer sample of boys with DMD (n=22) and healthy control boys (n=10), ages 5 through 14 years.

Interventions

Not applicable.

Main Outcome Measures

Maximal muscle cross-sectional area (CSA_max) assessed by magnetic resonance imaging of quadriceps, plantarflexors (PFs) and dorsiflexors (DFs), peak isometric torque from dynamometry, and timed functional tests.

Results

The average CSA_max of the triceps surae muscle group was approximately 60% higher in boys with DMD compared with controls (39.1±13.6 cm² vs 24.5±9.3 cm²; P=.002), while the tibialis anterior muscle showed age-appropriate increases in CSA_max. The increase in quadriceps CSA_max was also distinctly different in boys with DMD compared with controls. Specific torque (ie, peak torque/CSA_max) was impaired in all 3 muscles groups, with the knee extensor (KE) and PF muscles showing 4-fold, and the DF muscles 2-fold, higher values in controls compared with boys with DMD. Large age-related gains in specific torque were observed in all 3 muscle groups of control subjects, which were absent in ambulatory boys with DMD. Correlations were observed between performance on functional tasks and quadriceps and PF torque production (r=−.45 to −.57, P<.05), but not with DF strength.

Conclusions

Age-related changes in muscle cross-sectional area and specific torque production in lower-extremity muscles showed distinctly different patterns in the KE, PF, and DF muscles of boys with DMD compared with controls.     

The effectiveness of intradialytic leg ergometry exercise for improving sedentary life style and fatigue among patients with chronic kidney disease: A randomized clinical trial

Background

Over the past three decades, research has been carried out on the effects of exercise on chronic kidney disease patients for improving their physical potential.

Objectives

The purpose of this study is to evaluate the effect of intradialytic leg ergometry exercise for improving fatigue and daily physical activity levels among chronic kidney disease patients.

Design

A quasi-experimental clinical trial.

Setting

Two hemodialysis units in a medical center in northern Taiwan.

Method

The leg ergometry exercise was performed within the first hour of each hemodialysis session for 30 min for 8 weeks. There were 36 subjects in the experimental group and 35 subjects in the control group who completed the study. Measurement on a fatigue scale and a physical activity log were done at the time of enrollment, and again on the fourth and eighth weeks.

Result

Active subjects demonstrated significantly less fatigue and higher physical activity levels than those with a sedentary lifestyle at baseline. During the 8 weeks of intervention, subjects in both the active and sedentary groups reduced their fatigue levels significantly, with the exception of sedentary subjects in the control group. Only active subjects in the experimental group demonstrated an increase in activity levels. The 36 subjects performed 3456 leg ergometry exercise sessions with three early terminations (<.01%) among the sedentary subjects.

Conclusions

Intradialytic leg ergometry is a safe exercise that is effective to reduce fatigue and improve physical fitness in already active chronic kidney disease patients and it also reduces fatigue in sedentary patients. Interventions to motivate sedentary patients to become active require further investigation.

Implication for nursing practice

Exercise during hemodialysis does not cost patients extra time and is effective in reducing fatigue and increasing physical activity potential as demonstrated by our study; 30 min of intradialytic leg ergometer exercise can be considered as routine care while delivering hemodialysis.     

The Influence of Applying Additional Weight to the Affected Leg on Gait Patterns During Aquatic Treadmill Walking in People Poststroke

Jung T, Lee D, Charalambous C, Vrongistinos K. The influence of applying additional weight to the affected leg on gait patterns during aquatic treadmill walking in people poststroke.

Objective

To investigate how the application of additional weights to the affected leg influences gait patterns of people poststroke during aquatic treadmill walking.

Design

Comparative gait analysis.

Setting

University-based aquatic therapy center.

Participants

Community-dwelling volunteers (n=22) with chronic hemiparesis caused by stroke.

Interventions

Not applicable.

Main Outcome Measures

Spatiotemporal and kinematic gait parameters.

Results

The use of an ankle weight showed an increase in the stance phase percentage of gait cycle (3%, P=.015) when compared with no weight. However, the difference was not significant after a Bonferroni adjustment was applied for a more stringent statistical analysis. No significant differences were found in cadence and stride length. The use of an ankle weight showed a significant decrease of the peak hip flexion (7.9%, P=.001) of the affected limb as compared with no weight condition. This decrease was marked as the reduction of unwanted limb flotation because people poststroke typically show excessive hip flexion of the paretic leg in the late swing phase followed by fluctuating hip movements during aquatic treadmill walking. The frontal and transverse plane hip motions did not show any significant differences but displayed a trend of a decrease in the peak hip abduction during the swing phase with additional weights. The use of additional weight did not alter sagittal plane kinematics of the knee and ankle joints.

Conclusions

The use of applied weight on the affected limb can reduce unwanted limb flotation on the paretic side during aquatic treadmill walking. It can also assist the stance stability by increasing the stance phase percentage closer to 60% of gait cycle. Both findings can contribute to the development of more efficient motor patterns in gait training for people poststroke. The use of a cuff weight does not seem to reduce the limb circumduction during aquatic treadmill walking.     

The Effects of 12 Weeks of Resistance Exercise Training on Disease Severity and Autonomic Modulation at Rest and After Acute Leg Resistance Exercise in Women with Fibromyalgia

Kingsley JD, McMillan V, Figueroa A. The effects of 12 weeks of resistance exercise training on disease severity and autonomic modulation at rest and after acute leg resistance exercise in women with fibromyalgia.

Objective

To determine the effects of 12 weeks of resistance exercise training (RET) on disease severity and autonomic modulation at rest and after acute leg resistance exercise in women with fibromyalgia (FM) and healthy controls (HCs).

Design

Before-after trial.

Setting

Testing and training occurred in a university setting.

Participants

Women with FM (n=9; mean age ± SD, 42±5y) and HCs (n=15; mean age, 45±5y).

Intervention

Both groups underwent testing before and after 12 weeks of whole-body RET consisting of 3 sets of 8 to 12 repetitions on 5 different exercises.

Main Outcome Measures

Disease severity was assessed using the number of active tender points, myalgic score, and the Fibromyalgia Impact Questionnaire (FIQ). Heart rate and autonomic modulation using power spectral analysis of heart rate variability (HRV) were measured at rest and 20 minutes after 5 sets of leg-press exercise.

Results

There was no group-by-time interaction for any variable. Women with FM and HCs had similar increases in maximal strength (P<.05) after RET. Number of active tender points, myalgic score, and FIQ score were decreased (P<.05) after RET in women with FM. Heart rate and natural log (Ln) high frequency (LnHF) were recovered, whereas Ln low frequency (LnLF) and LnLF/LnHF ratio were increased (P<.05) 20 minutes after acute leg resistance exercise. There were no significant effects of RET on HRV at rest or postexercise.

Conclusions

These findings indicate that cardiovagal modulation of heart rate recovers early after leg resistance exercise in women with FM and HCs. It is concluded that RET reduces the severity of FM, but it has no impact on autonomic modulation of heart rate.     

Forward propulsion asymmetry is indicative of changes in plantarflexor coordination during walking in individuals with post-stroke hemiparesis

Background

A common measure of rehabilitation effectiveness post-stroke is self-selected walking speed, yet individuals may achieve the same speed using different coordination strategies. Asymmetry in the propulsion generated by each leg can provide insight into paretic leg coordination due to its relatively strong correlation with hemiparetic severity. Subjects walking at the same speed can exhibit different propulsion asymmetries, with some subjects relying more on the paretic leg and others on the nonparetic leg. The goal of this study was to assess whether analyzing propulsion asymmetry can help distinguish between improved paretic leg coordination versus nonparetic leg compensation.

Methods

Three-dimensional forward dynamics simulations were developed for two post-stroke hemiparetic subjects walking at identical speeds before/after rehabilitation with opposite changes in propulsion asymmetry. Changes in the individual muscle contributions to forward propulsion were examined.

Findings

The major source of increased forward propulsion in both subjects was from the ankle plantarflexors. How they were utilized differed and appears related to changes in propulsion asymmetry. Subject A increased propulsion generated from the paretic plantarflexors, while Subject B increased propulsion generated from the nonparetic plantarflexors. Each subject's strategy to increase speed also included differences in other muscle groups (e.g., hamstrings) that did not appear to be related to propulsion asymmetry.

Interpretation

The results of this study highlight how speed cannot be used to elucidate underlying muscle coordination changes following rehabilitation. In contrast, propulsion asymmetry appears to provide insight into changes in plantarflexor output affecting propulsion generation and may be useful in monitoring rehabilitation outcomes.     

Cardiovascular and metabolic responses during functional electric stimulation cycling at different cadences

Fornusek C, Davis GM. Cardiovascular and metabolic responses during functional electric stimulation cycling at different cadences.

Objective

To determine the influence of pedaling cadence on cardiorespiratory responses and muscle oxygenation during functional electric stimulation (FES) leg cycling.

Design

Repeated measures.

Setting

Laboratory.

Participants

Nine subjects with T4 through T10 spinal cord injury (SCI) (American Spinal Injury Association grade A).

Interventions

FES cycling was performed at pedaling cadences of 15, 30, and 50 revolutions per minute (rpm).

Main Outcome Measures

At each cadence, heart rate, oxygen uptake, and cardiac output were recorded during 35 minutes of cycling. Near infrared spectroscopy was used to quantify quadriceps muscle oxygenation.

Results

All pedaling cadences induced similar elevations in cardiorespiratory metabolism, compared with resting values. Higher average power output was produced at 30rpm (8.2±0.7W, P<.05) and 50rpm (7.9±0.5W, P<.05) compared with 15rpm (6.3±0.6W). Gross mechanical efficiency was significantly higher (P<.05) at 30 and 50rpm than at 15rpm. Quadriceps muscle oxygenation did not differ with pedaling cadences.

Conclusions

Cardiorespiratory responses and muscle metabolism adjustments during FES leg cycling were independent of pedal cadence. FES cycling at a cadence of 50rpm may not confer any advantages over 30 or 15rpm for cardiovascular fitness promotion in persons with SCI.     

Self-Management Improves Outcomes in Persons With Limb Loss

Wegener ST, Mackenzie EJ, Ephraim P, Ehde D, Williams R. Self-management improves outcomes in persons with limb loss.

Objective

To test the acceptance and effectiveness of a community-based self-management (SM) intervention designed to improve outcomes after limb loss. A priori hypothesis was that an SM intervention will be more effective than standard support group activities in improving outcomes.

Design

Randomized controlled trial.

Setting

General community.

Participants

Intervention (N=287) and control participants (N=235) with major limb loss.

Intervention(s)

Nine, 90-minute SM group sessions delivered by trained volunteer leaders. Retention rates at immediate postintervention and 6-month follow-up were 97% and 91% for the SM group.

Main Outcome Measure(s)

Primary outcomes were depression, positive mood, and self-efficacy. Secondary outcomes were improved functional status and quality of life.

Results

By using intent-to-treat analyses, the odds for being depressed are significantly lower for those in SM group, 50% less likely at treatment completion (95% confidence interval [CI]=0.3-0.9) and 40% less likely at the 6-month follow-up (95% CI=.03-1.1). Treatment completers have a 70% reduction in likelihood of being depressed at posttreatment (P<.01) and this persists at six months (P<.05). For those in the SM group, functional limitations were significantly lower at 6 months (P<.05), and general self-efficacy was significantly higher at immediate posttreatment (P<.05) and at 6 months (P<.05). Treatment completers have generally significantly larger effect sizes at all follow-up points. Pain intensity, self-efficacy for pain control, and quality of life were not significantly different between the groups. Subgroup analyses indicated the impact of the intervention was greater for participants who were less than 3 years postamputation, participants who were less than 65 years of age, or participants who showed at least 1 secondary condition at baseline.

Conclusions

The study provides evidence that SM interventions can improve the outcomes of persons with limb loss beyond benefits offered by support groups.     

Effects of Motor Imagery on Hand Function During Immobilization After Flexor Tendon Repair

Stenekes MW, Geertzen JH, Nicolai J-P, De Jong BM, Mulder T. Effects of motor imagery on hand function during immobilization after flexor tendon repair.

Objective

To determine whether motor imagery during the immobilization period after flexor tendon injury results in a faster recovery of central mechanisms of hand function.

Design

Randomized controlled trial.

Setting

Tertiary referral hospital.

Participants

Patients (N=28) after surgical flexor tendon repair were assigned to either an intervention group or a control group.

Intervention

Kinesthetic motor imagery of finger flexion movements during the postoperative dynamic splinting period.

Main Outcome Measures

The central aspects of hand function were measured with a preparation time test of finger flexion in which subjects pressed buttons as fast as possible following a visual stimulus. Additionally, the following hand function modalities were recorded: Michigan Hand Questionnaire, visual analog scale for hand function, kinematic analysis of drawing, active total motion, and strength.

Results

After the immobilization period, the motor imagery group demonstrated significantly less increase of preparation time than the control group (P=.024). There was no significant influence of motor imagery on the other tested hand function (P>.05). All tests except kinematic analysis (P=.570) showed a significant improvement across time after the splinting period (P≤.001).

Conclusions

Motor imagery significantly improves central aspects of hand function, namely movement preparation time, while other modalities of hand function appear to be unaffected.     

Is Fatigue Associated With Short-Term Health-Related Quality of Life in Stroke?

Tang WK, Lu JY, Chen YK, Mok VC, Ungvari GS, Wong KS. Is fatigue associated with short-term health-related quality of life in stroke?

Objective

To evaluate the relation between poststroke fatigue and short-term health-related quality of life (HRQOL) in Chinese patients with first or recurrent stroke.

Design

Cross-sectional survey.

Setting

Acute stroke unit of a general hospital.

Participants

A total of 458 patients with acute ischemic stroke admitted to the acute stroke unit of a university-affiliated regional hospital in Hong Kong.

Interventions

Not applicable.

Main Outcome Measures

HRQOL was assessed with the Medical Outcomes Study 36-Item Short Form Health Survey (SF-36) at 3 months after the subjects' index stroke. Fatigue was evaluated by using the Fatigue Severity Scale (FSS). The correlation between the FSS and SF-36 scores was examined and adjusted for potential confounders, including age, sex, marital status, previous stroke, social support, global cognitive functions, neurologic deficits, and depressive symptoms.

Results

Univariate analysis revealed that fatigue was a significant correlate of all SF-36 domain scores. The magnitude of correlation was highest for the vitality domain (r=−.605, Bonferroni corrected P<.05) and lowest for the physical functioning domain (r=−.202, Bonferroni corrected P<.05). Canonic correlation analysis indicated that FSS was strongly related to the HRQOL with a loading of −.678. Increasing fatigue was associated with a lower HRQOL. The association between FSS and HRQOL remained significant in the subsequent multivariate regression analysis, having adjusted for possible confounders.

Conclusions

These findings suggest that fatigue has an impact on short-term HRQOL in Chinese stroke patients. The early identification and treatment of fatigue may improve HRQOL of stroke patients.     

Training program and additional electric muscle stimulation for patellofemoral pain syndrome: a pilot study

Bily W, Trimmel L, Mödlin M, Kaider A, Kern H. Training program and additional electric muscle stimulation for patellofemoral pain syndrome: a pilot study.

Objectives

To evaluate the beneficial effect of training in patients with patellofemoral pain syndrome (PFPS) and influence of additional electric muscle stimulation (EMS) of the knee extensor muscles.

Design

A randomized clinical trial.

Setting

Supervised physiotherapy (PT) training and home-based EMS.

Participants

Patients (N=38; 14 men, 24 women) with bilateral PFPS.

Interventions

One group (PT) received supervised PT training for 12 weeks. The other received PT and EMS. The stimulation protocol was applied to the knee extensors for 20 minutes, 2 times daily, 5 times a week for 12 weeks at 40Hz, with a pulse duration of .26ms, at 5 seconds on and 10 seconds off. Maximal tolerable stimulation intensity was up to 80mA.

Main Outcome Measures

Patellofemoral pain assessment with visual analog scale during activities of daily life, Kujala patellofemoral score, and isometric strength measurement before and after 12 weeks treatment as well as after 1 year.

Results

Thirty-six patients completed the 12-week follow-up. There was a statistically significant reduction of pain in both groups (PT group, P=.003; PT and EMS group, P<.001) and significant improvement of the Kujala score in both groups (PT group, P<.001; PT and EMS group, P<.001) after 12 weeks of treatment with improvement of function and reduction of pain at the 1-year follow-up. The difference between the 2 treatment groups was statistically not significant. We could not measure any significant change in isometric knee extensor strength in either group.

Conclusions

A supervised PT program can reduce pain and improve function in patients with PFPS. We did not detect a significant additional effect of EMS with the protocol described previously.     

The cost and benefits of employment: a qualitative study of experiences of persons with multiple sclerosis

Johnson KL, Yorkston KM, Klasner ER, Kuehn CM, Johnson E, Amtmann D. The cost and benefits of employment: a qualitative study of experiences of persons with multiple sclerosis. Arch Phys Med Rehabil 2004;85:201-9.

Objective

To attain a better understanding of the benefits and barriers faced by persons with multiple sclerosis (MS) in the workplace.

Design

Qualitative research methodology comprising a series of semistructured interviews.

Setting

Community-based setting.

Participants

Fourteen women and 2 men with MS living in the community who were employed or recently employed at the time of interviews.

Interventions

Not applicable.

Main outcome measure

Accounts of personal experiences related to employment.

Results

Four themes emerged: the cost-benefit economy of working; fatigue and cognitive changes; stress in the workplace; and accommodations made to address barriers. Although participants valued work highly, they were also aware of the cost of being employed. The consequences of unemployment or changing jobs were considered negative and appeared stressful. For persons with MS, employment had both costs and significant benefits. Accommodations in the workplace and modifications of roles and responsibilities at home made it possible for individuals to continue working.

Conclusions

Health care providers must consider the complexity and timing of decisions by people with MS to continue or leave employment before recommending either action. Identifying critical periods of intervention to stabilize this cost-benefit balance is a critical next step for understanding issues of employment and MS.     

Relationship Among Shoulder Proprioception, Kinematics, and Pain After Stroke

Niessen MH, Veeger DH, Meskers CG, Koppe PA, Konijnenbelt MH, Janssen TW. Relationship among shoulder proprioception, kinematics, and pain after stroke.

Objective

To identify a possible relationship among chronic poststroke shoulder pain (PSSP), scapular resting pose, and shoulder proprioception.

Design

Case-control study.

Setting

Rehabilitation center.

Participants

A total of 21 inpatients with stroke and 10 healthy control subjects.

Interventions

Not applicable.

Main Outcome Measures

Orientations of both the contralateral and ipsilateral (ie, paretic and nonparetic) shoulders during rest in degrees, angular displacement (degrees) for threshold to detection of passive motion (TDPM) tests, and absolute error (degrees) for passive reproduction of joint position (PRJP) tests.

Results

The contralateral shoulder of patients with PSSP showed more scapular lateral rotation and larger TDPM and PRJP scores than both patients without PSSP and control subjects. Additionally, the contralateral shoulder of patients with deteriorated proprioception showed more scapular lateral rotation than control subjects, whereas their ipsilateral shoulder showed more scapular lateral rotation than both control subjects and patients with good proprioception.

Conclusions

A clear relation among affected shoulder kinematics, affected proprioception, and PSSP was found. In determining the risk of developing PSSP, attention should be paid to a patients shoulder proprioception and kinematics. If both are altered after stroke, this could worsen the initial pathology or cause secondary pathologies and thus initiate a vicious circle of repetitive soft tissue damage leading to chronic PSSP. Additionally, more attention should be paid to the ipsilateral (ie, nonparetic) shoulder because it could be used in determining the risk of developing PSSP in the contralateral (ie, paretic) shoulder.